Stressful Life Events

Stressful life events, including childhood trauma, have been associated with the development of som-atization later in life (Campo and Fritsch 1994). Chronic stressors can have an effect on the body's stress response systems, such as the hypothalamic-pituitary-adrenal (HPA) axis. Although elevations of cortisol may be associated with acute stress, prolonged exposure to stress can suppress the HPA axis, resulting in the lowered cortisol levels that are associated with somatic complaints (Lackner et al. 2004). Somatoform symptoms have been linked to traumatic events experienced in both childhood and adulthood (Binzer et al. 1997; Roelofs et al. 2002). Roelofs et al. (2005) have found that the number of traumatic events an individual has experienced is associated with the number of conversion disorder symptoms exhibited. Of traumatic events experienced, those pertaining to relationship and occupational problems are most likely to trigger immediate somatic symptoms in adults (Roelofs et al. 2005). Evidence suggests that childhood traumatic events alone may not have the power to trigger somatic symptoms but rather that events experienced as an adult together with previous childhood trauma may result in heightened somatic complaints (Roelofs et al. 2005).

A high correlation has been found between sexual abuse and somatic symptoms (Brooks 1985; Campo and Fritsch 1994). Salmon et al. (2003) showed a significant associations between sexual abuse, psychological abuse, and somatization in patients who have nonepileptic seizures. In a study of Finnish high school students, Poikolainen et al. (1995) found significant correlations between somatic symptoms and several psychosocial stressors, including family conflict, physical injury or illness in the family, breakup with a boyfriend or girlfriend, and increased parental absence. In a study of adults with hypochondriasis, Barsky et al. (1994) found that hypochondriacal adult patients recalled more conflict between parents, more traumatic childhood sexual experiences, and more victimization by violence than did a comparison group. In a study comparing 22 adults with a history of unexplained somatic symptoms with healthy controls, R. J. Brown et al. (2005) found that the former group had more reported emotional and physical abuse and that the number of unexplained symptoms correlated significantly with the severity of the abuse.

In a study of 892 adult psychiatric outpatients, Sack et al. (2007) found that compared with non-traumatized patients, sexually traumatized patients reported a significantly higher incidence of somatic complaints pertaining to pain or discomfort in sexual organs or sexual indifference. In their study of women with headache and lower back pain, Yucel et al. (2002) found that physical abuse and neglect were the most commonly reported types of childhood maltreatment.